Healthcare Provider Details

I. General information

NPI: 1891173548
Provider Name (Legal Business Name): MS. DIANNA MARIE O'NEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNA MARIE DEARDORFF

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 100TH ST
URBANDALE IA
50322-3860
US

IV. Provider business mailing address

5628 WISTFUL VISTA DR
WEST DES MOINES IA
50266-2854
US

V. Phone/Fax

Practice location:
  • Phone: 515-218-9223
  • Fax: 515-349-6865
Mailing address:
  • Phone: 515-218-9223
  • Fax: 515-349-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA121525
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: